Post-test mei 2021 aantekeningen
Retroperitoneum kan worden assessed met
- CT
- Laparoscopie
- DPL
- FAST
- Angiografie
Wat is normaal in het derde trimester?
- Minder plasma
- Minder totaal red blood cell mass
- Verwijding van symphysis pubis
Wat heeft het grootste risico gemist te worden met DPL?
- Jejunumletsel
- Colonperforatie
- Subcapsulair splenic hematoom
- Mesenteriumletsel
Een man heeft zich geprobeerd te verhangen. Hij heeft subcutaan oedeem van de hals en een stridor.
Wat doe je?
- Chirurgische tracheostomie op OK
- Laryngoscopie met plaatsen endotracheale tube
Wat zijn gevolgen/tekenen van een verhoogde ICP
- Vertraagde hartslag en ademfrequentie, stijging systolische bloeddruk
- Irregulaire hartslag, ademfrequentie en hypertensie
- Verhoogde hartslag, ademfrequentie en hypertensie
- Verhoogde hartslag en ademfrequentie met verlaagde bloeddruk
Welke obstructie wordt meestal met een oral airway opgelost?
- De naar achter gevallen tong
- Mucus/bloed
- Corpus alienum
Wat is een reden om te verwijzen naar een brandwondencentrum
- Brandwonden hals
- Blaarvorming
- >10% TBSA
Een man na abdominaal trauma met vocht rondom de lever op echo FAST. Wat is je volgende stap?
- CT-abdomen
- laparoscopie/laparotomie
- FAST herhalen na 24 uur
Oude dame heeft rib 3 t/m 9 gebroken. Wat is je initiële management?
- Pijnmedicatie
- Assessment of oygenation
,Patiënt van middelbare leeftijd met gestuwde halsvenen. Wat is het minst waarschijnlijk?
- Harttamponade
- Spanningspneu
- Vena cava trombose
- Aortaruptuur
- Pre-existent hartfalen
Hemodynamisch stabiele jonge patiënt met steekwond abdomen. Wat is je volgende stap?
- Herhaal lichamelijk onderzoek
- X-BOZ
- Laparatomie
Man na ongeval heeft links al een drain gekregen ivm pneumothorax. 200cc bloed uitgekomen.
- Opnieuw X-thorax (re-evaluate)
Welke stelling is juist betreffende neurogene shock?
- Onder niveau T6 is neurogene shock erg onwaarschijnlijk
Welke stelling betreffende geriatrisch hoofd trauma is juist?
- Helft van overlijdens na val zijn het gevolg van intracranieel letsel
Vrouw met hoofdtrauma, bloedende wond, redelijke controles
- Wond afdrukken
- Infuus geven
- CT maken
Welke stelling betreffende wervelkolom is juist
- Cervicale wervelkolom is het meest flexibel en meest exposed en daarom zijn cervicale
letsels het meest voorkomend.
- het wervelkanaal wordt gevorm de door processus spinosi en processus nogwat
- ossale letsels t.h.v. C1 leiden vaker tot ruggenmergletsel omdat het wervelkanaal daar het
nauwste is
Contraindicaties van nasogastric tube. (niet: skull fracture). Antwoord: midface fracture(?)
Andere toets
Man van 80 kg, heeft 50% van z’n body surface area verbrand, 3 uur na ongeval heeft hij 1L infuus
gehad. Wat moet nu de infuusstand zijn de komende 5 uur?
50x80x2= 8L. Eerste helft in 8 uur. Dus nu nog 3L in 5 uur = 600cc per uur.
(hier dus ATLS boek aanhouden (volwassenen 2cc, kinderen 3cc, elektrische verbrandingen 4cc per kg
per procent verbrand lichaamsoppervlak)).
,Online pre-test
Q1. A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His
blood pressure is initially 80/40 mm Hg. After initial fluid resuscitation, his blood pressure increases
to 122/84 mm Hg. His heart rate is now 100 beats per minute and his respiratory rate is 28 breaths
per minute. A tube thoracostomy is performed for decreased left chest breath sounds with the
return of a small amount of blood and no air leak. After chest tube insertion, the most appropriate
next step is:
- Reexamine the chest
- Obtain a computed tomography (CT) scan of the chest
- Perofrm an aortogram
- Obtain arterial blood gas analyses
Q2. A construction worker falls two stories from a building and sustains bilateral calcaneal fractures.
In the emergency department (ED), he is alert, his vital signs are normal, and he is complaining of
severe pain in both heels and his lower back. Lower extremity pulses are strong and there is no other
deformity. The suspected diagnosis is most likely to be confirmed by:
- Complete spine x-ray series
- Compartment pressures
- Retrograde urethrogram
- Angiography
- Doppler ultrasound studies
Q3. Which of the following is true regarding the initial resuscitation of a trauma patient?
- A patient with a torso gunshot wound and hypotension should receive crystalloid fluid
resuscitation until the blood pressure is normal.
- Massive transfusion is defined as transfusion of more than 10 units of packed red blood cells
and plasma within 24 hours.
- Evidence of improved perfusion after fluid resuscitation could include improvement in
Glasgow Coma Scale (GCS) score on reevaluation.
- Fluid resuscitation is far more important than bleeding control in trauma patients.
- When tranexamic acid is administered by prehospital providers, a second dose is required
within 24 hours.
Q4. In managing a patient with a severe traumatic brain injury, the most important initial step is to:
Select one:
- Determine the GCS score
- Secure the airway
- Obtain a c-spine film
- Control scalp hemorrhage
- Support the circulation
Q5. A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2 liters.
Which statement applies to this patient?
- He will have tachycardia but no change in his systolic blood pressure.
- His pulse pressure will be widened.
- An arterial blood gas would demonstrate a base deficit between –6 and –10 mEq/L.
- His urinary output will be at the lower limits of normal.
- His systolic blood pressure will be maintained with an elevated diastolic pressure.
, Q6. The physiological hypervolemia of pregnancy has clinical significance in the management of the
severely injured, gravid woman by:
- Reducing the volume of crystalloid required for resuscitation.
- Complicating the management of closed head injury.
- Resulting in an elevated hematocrit.
- Increasing the volume of blood loss to produce maternal hypotension.
- Reducing the need for blood transfusion.
Q7. The best assessment of fluid resuscitation of the adult burn patient is:
- Measuring a normal central venous pressure
- Normalization of the heart rate
- Providing 4 mL/kg/percent body burned/24 hours of crystalloid fluid
- Urinary output of 0.5 ml/kg/hr (adequate urinary output)
- Normalization of blood pressure
Q8. The diagnosis of shock must include
- Hypotension
- Hypoxemia
- Increased vascular resistance
- Evidence of inadequate organ perfusion
- Acidosis
Q9. A 7-year-old boy is brought to the ED by his parents several minutes after he fell through a
window. He is bleeding profusely from a 6-cm wound in his medial right thigh. Immediate
management of the wound should consist of:
- Applying a tourniquet
- Packing the wound with gauze
- Debriding devitalized tissue
- Applying direct pressure on the wound
- Applying direct pressure on the femoral artery at the groin
Q10. For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to
prevent
- Shift of the oxyhemoglobin dissociation curve
- Neurogenic pulmonary edema
- Metabolic acidosis
- Respiratory acidosis
- Cerebral vasoconstriction with diminished perfusion
Q11. After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that
has surgery capabilities available. CT of the chest and abdomen shows an aortic injury and splenic
laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next step is
to:
- Obtain contrast angiography
- Transfer him to a higher-level trauma center
- Infuse additional crystalloid fluids
- Obtain transesophageal echocardiography
- Perform an exploratory laparotomy
Retroperitoneum kan worden assessed met
- CT
- Laparoscopie
- DPL
- FAST
- Angiografie
Wat is normaal in het derde trimester?
- Minder plasma
- Minder totaal red blood cell mass
- Verwijding van symphysis pubis
Wat heeft het grootste risico gemist te worden met DPL?
- Jejunumletsel
- Colonperforatie
- Subcapsulair splenic hematoom
- Mesenteriumletsel
Een man heeft zich geprobeerd te verhangen. Hij heeft subcutaan oedeem van de hals en een stridor.
Wat doe je?
- Chirurgische tracheostomie op OK
- Laryngoscopie met plaatsen endotracheale tube
Wat zijn gevolgen/tekenen van een verhoogde ICP
- Vertraagde hartslag en ademfrequentie, stijging systolische bloeddruk
- Irregulaire hartslag, ademfrequentie en hypertensie
- Verhoogde hartslag, ademfrequentie en hypertensie
- Verhoogde hartslag en ademfrequentie met verlaagde bloeddruk
Welke obstructie wordt meestal met een oral airway opgelost?
- De naar achter gevallen tong
- Mucus/bloed
- Corpus alienum
Wat is een reden om te verwijzen naar een brandwondencentrum
- Brandwonden hals
- Blaarvorming
- >10% TBSA
Een man na abdominaal trauma met vocht rondom de lever op echo FAST. Wat is je volgende stap?
- CT-abdomen
- laparoscopie/laparotomie
- FAST herhalen na 24 uur
Oude dame heeft rib 3 t/m 9 gebroken. Wat is je initiële management?
- Pijnmedicatie
- Assessment of oygenation
,Patiënt van middelbare leeftijd met gestuwde halsvenen. Wat is het minst waarschijnlijk?
- Harttamponade
- Spanningspneu
- Vena cava trombose
- Aortaruptuur
- Pre-existent hartfalen
Hemodynamisch stabiele jonge patiënt met steekwond abdomen. Wat is je volgende stap?
- Herhaal lichamelijk onderzoek
- X-BOZ
- Laparatomie
Man na ongeval heeft links al een drain gekregen ivm pneumothorax. 200cc bloed uitgekomen.
- Opnieuw X-thorax (re-evaluate)
Welke stelling is juist betreffende neurogene shock?
- Onder niveau T6 is neurogene shock erg onwaarschijnlijk
Welke stelling betreffende geriatrisch hoofd trauma is juist?
- Helft van overlijdens na val zijn het gevolg van intracranieel letsel
Vrouw met hoofdtrauma, bloedende wond, redelijke controles
- Wond afdrukken
- Infuus geven
- CT maken
Welke stelling betreffende wervelkolom is juist
- Cervicale wervelkolom is het meest flexibel en meest exposed en daarom zijn cervicale
letsels het meest voorkomend.
- het wervelkanaal wordt gevorm de door processus spinosi en processus nogwat
- ossale letsels t.h.v. C1 leiden vaker tot ruggenmergletsel omdat het wervelkanaal daar het
nauwste is
Contraindicaties van nasogastric tube. (niet: skull fracture). Antwoord: midface fracture(?)
Andere toets
Man van 80 kg, heeft 50% van z’n body surface area verbrand, 3 uur na ongeval heeft hij 1L infuus
gehad. Wat moet nu de infuusstand zijn de komende 5 uur?
50x80x2= 8L. Eerste helft in 8 uur. Dus nu nog 3L in 5 uur = 600cc per uur.
(hier dus ATLS boek aanhouden (volwassenen 2cc, kinderen 3cc, elektrische verbrandingen 4cc per kg
per procent verbrand lichaamsoppervlak)).
,Online pre-test
Q1. A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His
blood pressure is initially 80/40 mm Hg. After initial fluid resuscitation, his blood pressure increases
to 122/84 mm Hg. His heart rate is now 100 beats per minute and his respiratory rate is 28 breaths
per minute. A tube thoracostomy is performed for decreased left chest breath sounds with the
return of a small amount of blood and no air leak. After chest tube insertion, the most appropriate
next step is:
- Reexamine the chest
- Obtain a computed tomography (CT) scan of the chest
- Perofrm an aortogram
- Obtain arterial blood gas analyses
Q2. A construction worker falls two stories from a building and sustains bilateral calcaneal fractures.
In the emergency department (ED), he is alert, his vital signs are normal, and he is complaining of
severe pain in both heels and his lower back. Lower extremity pulses are strong and there is no other
deformity. The suspected diagnosis is most likely to be confirmed by:
- Complete spine x-ray series
- Compartment pressures
- Retrograde urethrogram
- Angiography
- Doppler ultrasound studies
Q3. Which of the following is true regarding the initial resuscitation of a trauma patient?
- A patient with a torso gunshot wound and hypotension should receive crystalloid fluid
resuscitation until the blood pressure is normal.
- Massive transfusion is defined as transfusion of more than 10 units of packed red blood cells
and plasma within 24 hours.
- Evidence of improved perfusion after fluid resuscitation could include improvement in
Glasgow Coma Scale (GCS) score on reevaluation.
- Fluid resuscitation is far more important than bleeding control in trauma patients.
- When tranexamic acid is administered by prehospital providers, a second dose is required
within 24 hours.
Q4. In managing a patient with a severe traumatic brain injury, the most important initial step is to:
Select one:
- Determine the GCS score
- Secure the airway
- Obtain a c-spine film
- Control scalp hemorrhage
- Support the circulation
Q5. A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2 liters.
Which statement applies to this patient?
- He will have tachycardia but no change in his systolic blood pressure.
- His pulse pressure will be widened.
- An arterial blood gas would demonstrate a base deficit between –6 and –10 mEq/L.
- His urinary output will be at the lower limits of normal.
- His systolic blood pressure will be maintained with an elevated diastolic pressure.
, Q6. The physiological hypervolemia of pregnancy has clinical significance in the management of the
severely injured, gravid woman by:
- Reducing the volume of crystalloid required for resuscitation.
- Complicating the management of closed head injury.
- Resulting in an elevated hematocrit.
- Increasing the volume of blood loss to produce maternal hypotension.
- Reducing the need for blood transfusion.
Q7. The best assessment of fluid resuscitation of the adult burn patient is:
- Measuring a normal central venous pressure
- Normalization of the heart rate
- Providing 4 mL/kg/percent body burned/24 hours of crystalloid fluid
- Urinary output of 0.5 ml/kg/hr (adequate urinary output)
- Normalization of blood pressure
Q8. The diagnosis of shock must include
- Hypotension
- Hypoxemia
- Increased vascular resistance
- Evidence of inadequate organ perfusion
- Acidosis
Q9. A 7-year-old boy is brought to the ED by his parents several minutes after he fell through a
window. He is bleeding profusely from a 6-cm wound in his medial right thigh. Immediate
management of the wound should consist of:
- Applying a tourniquet
- Packing the wound with gauze
- Debriding devitalized tissue
- Applying direct pressure on the wound
- Applying direct pressure on the femoral artery at the groin
Q10. For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to
prevent
- Shift of the oxyhemoglobin dissociation curve
- Neurogenic pulmonary edema
- Metabolic acidosis
- Respiratory acidosis
- Cerebral vasoconstriction with diminished perfusion
Q11. After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that
has surgery capabilities available. CT of the chest and abdomen shows an aortic injury and splenic
laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next step is
to:
- Obtain contrast angiography
- Transfer him to a higher-level trauma center
- Infuse additional crystalloid fluids
- Obtain transesophageal echocardiography
- Perform an exploratory laparotomy
